Case Study

Focal Fatty Infiltration

Focal Fatty Infiltration is a benign imaging finding characterized by localized deposition of fat within a specific region of the liver while the remaining hepatic parenchyma appears relatively normal. These areas are typically hyperechoic on ultrasound and are commonly located adjacent to the falciform ligament, gallbladder fossa, porta hepatis, or subcapsular regions. Recognition of focal fatty infiltration is important because it may simulate focal hepatic masses; however, it usually demonstrates geographic margins, preserved vascular architecture, and absence of mass effect, helping differentiate it from true hepatic lesions.

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Whole Abdomen & Pelvis Sonography

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Technique: Examination performed using a convex 3.5–5 MHz transducer. Longitudinal and transverse planes of the abdomen were evaluated. Color Doppler assessment of hepatic and portal vessels was performed. Pelvic and post-void images were obtained. Patient was fasting for 6–8 hours.
Prior studies: No prior imaging available.
Clinical history: Routine sonographic evaluation.

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Liver: Liver demonstrates mildly increased echogenicity. Shows multiples focal geographic hyperechoic area is seen within the hepatic parenchyma, without mass effect or distortion of adjacent vascular structures, consistent with focal fatty infiltration. No focal hepatic mass lesion is identified. Intrahepatic biliary radicles are not dilated. Portal vein is normal in caliber with normal hepatopetal flow. Gall Bladder: Gall bladder is normal in size, shape, and echotexture. No calculus, mass, or sludge is seen. Wall thickness is normal. Common Bile Duct (CBD): CBD is normal in course and caliber throughout its visualized length. Pancreas: Pancreas is normal in size, shape, and echotexture. Main pancreatic duct is not dilated. No focal mass or calcification is seen. Spleen: Spleen is normal in size, shape, and echotexture. Splenic vein appears normal. No focal lesion or calcification is seen. Right Kidney: Right kidney is normal in size, shape, and echotexture. Corticomedullary differentiation is preserved. Pelvicalyceal system is not dilated. No calculus, hydronephrosis, or mass lesion is seen. Left Kidney: Left kidney is normal in size, shape, and echotexture. Corticomedullary differentiation is preserved. Pelvicalyceal system is not dilated. No calculus, hydronephrosis, or mass lesion is seen. Rt. Ureter: Right ureter is visualized in its proximal segment. No evidence of dilatation. No intraluminal calculus is seen. Lt. Ureter: Left ureter is visualized in its proximal segment. No evidence of dilatation. No intraluminal calculus is seen. Urinary Bladder: Urinary bladder is adequately distended. Wall thickness appears normal. No intraluminal mass or debris is seen. Post-void residual urine is insignificant. Prostate: Prostate volume is within normal limits. Echotexture appears homogeneous. Free Fluid: No free fluid is seen in the abdomen or pelvis.

Other Observations: No abdominal lymphadenopathy identified. Visualized bowel loops are unremarkable. Appendix is not visualized; no sonographic evidence of acute appendicitis. Bilateral inguinal regions are unremarkable without hernia or significant lymphadenopathy.

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Measurement Summary:

Liver: 142 mm	Spleen: 97 mm
RK: 92 mm	LK: 90 mm
Prostate: 7.5 mL

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Impression: Focal fatty infiltration of the liver. No focal hepatic mass lesion identified. Otherwise unremarkable ultrasound study of the abdomen and pelvis.

Recommendation: Clinical correlation advised.

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Limitations / Technical Factors: Ultrasound evaluation may not detect subtle bowel or early parenchymal abnormalities. Correlation with clinical findings is recommended.

• This report and accompanying images are not valid for medico-legal purposes.

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Focal Fatty Infiltration – MCQs

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1. What is focal fatty infiltration?
A. Localized hepatic calcification
B. Localized deposition of fat within the liver
C. Liver abscess formation
D. Portal vein thrombosis

2. Focal fatty infiltration most commonly occurs in:
A. Completely normal liver
B. Diffuse fatty liver disease
C. Polycystic liver disease
D. Hepatic trauma

3. On ultrasound, focal fatty infiltration usually appears:
A. Hypoechoic
B. Anechoic
C. Hyperechoic relative to normal liver
D. Calcified

4. A common location for focal fatty infiltration is:
A. Adjacent to the falciform ligament
B. Renal cortex
C. Splenic hilum
D. Pancreatic tail

5. Focal fatty infiltration is generally considered:
A. Malignant
B. Infective
C. Benign
D. Traumatic

6. Which structure is commonly associated with focal fatty infiltration?
A. Coronary ligament
B. Falciform ligament
C. Broad ligament
D. Ureter

7. Focal fatty infiltration may mimic:
A. Hepatic mass lesion
B. Renal stone
C. Gallstone
D. Pancreatitis

8. Recognition of focal fatty infiltration helps avoid:
A. Portal hypertension
B. Misdiagnosis of a liver tumor
C. Ascites
D. Splenomegaly

9. Focal fatty infiltration characteristically demonstrates:
A. Significant mass effect
B. Distortion of vessels
C. Preserved vascular architecture
D. Extensive calcification

10. Focal fatty infiltration most commonly affects which organ?
A. Kidney
B. Pancreas
C. Liver
D. Spleen

📝 Focal Fatty Infiltration – Answer Sheet

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1. __________

2. __________

3. __________

4. __________

5. __________

6. __________

7. __________

8. __________

9. __________

10. __________

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Correct Answers

1. B, 2. B, 3. C, 4. A, 5. C, 6. B, 7. A, 8. B, 9. C, 10. C